The frequency of degenerative changes in the sternoclavicular joint may be underestimated using plain films. Such changes are frequently found at computed tomography (CT) (6) or pathologic (5) examinations in asymptomatic people over 60 years of age. Discomfort and soft-tissue swelling about the proximal end of the clavicle may, however, commonly occur in females of 50 years of age. Long-lasting limitation of the glenohumeral joint due to resistant rotator cuff tendonitis or frozen shoulder might favor overuse, and thus degenerative changes of the sternoclavicular joint in these patients (7). Symptomatic overuse of the sternoclavicular joint is also encountered in manual workers having frequent sustained shoulder abduction of more than 90° or those commonly wearing heavy loads on their shoulder. In some patients, pain from the sternoclavicular joint may project onto the shoulder. Uncommonly, sternoclavicular synovitis or synovial cyst may be found at magnetic resonance (MR) examination (Fig. 7). Discomfort may also occur in both homolateral acromioclavicular and sternoclavicular joints in some

FIGURE 7 Axial T2-weighted magnetic resonance scan of a synovial cyst (solid arrow) connected with the articular surface (open arrow) of the head of the clavicle in a degenerative sternoclavicular joint.

patients who underwent long-lasting extended cervicotomy due to the mechanical stress of spacers on these joints.

Steroid injection under radiological guidance may also be indicated in some patients with sternoclavicular arthritis associated with seronegative spondylarthropathy or Synovitis, Acne, P. cestulosis, Hyperostosis and Osteitis (SAPHO) syndrome (8), when nonsteroid anti-inflammatory drugs are not effective. Twenty percent of the cases of septic osteoarthritides occurring in drug addicted people involve the sternoclavicular or sternocostal joints (9). In this situation, management of samples should also be appropriate to peculiar microorganisms. Permanent subclavian catheter is another potential cause of sternoclavicular joint infection. Joint space aspiration under radiological guidance may be indicated for bacteriological culture purposes.

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Dealing With Back Pain

Dealing With Back Pain

Deal With Your Pain, Lead A Wonderful Life An Live Like A 'Normal' Person. Before I really start telling you anything about me or finding out anything about you, I want you to know that I sympathize with you. Not only is it one of the most painful experiences to have backpain. Not only is it the number one excuse for employees not coming into work. But perhaps just as significantly, it is something that I suffered from for years.

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